Ob-Gyn Coding Alert

Question: I know some of these codes are bundled, but I’m unsure how to correctly bill the op report, which includes diagnostic laparoscopy, lysis of adhesions, radical excision of endome­triosis, fulguration of endometriosis and a right salpingo-oophorectomy. What should I report?

Colorado Subscriber

Answer: Code 58660 (Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure)) for the lysis of adhesions is a National Correct Coding Initiative (NCCI) column 2 edit for both 58661 (… with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy) and 58662 (… with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method).

Basically, you should include lysis of adhesions in almost all surgeries, whether laparoscopic or open. If the lysis of adhesions is extensive, and documented as such, then sometimes you can use modifier 22 (Increased procedural service) on the main procedure.

Therefore, you should code this as:

• 58662
• 58661-XU-RT (Unusual non-overlapping service,… Right side)

Note: While the 58661 is not an edit, many carriers do want to bundle it.

Important: You should also ensure you have separate diagnoses (assuming warranted) for each. This is also assuming all procedures were laparoscopic and patient was not converted to open (not 100% clear from your question but seems very likely).